Background.To comprehensively assess surgical safety, we conducted a meta-analysis on neoadjuvant chemo-immunotherapy for NSCLC.Methods.This systematic review and meta-analysis followed PRISMA guidelines (PROSPERO: CRD42023470682). A literature search and data extraction were performed independently by two reviewers. Primary outcomes included surgical feasibility and safety. Pooled prevalence proportions with 95% confidence intervals (CIs) were calculated. A random-effects model was applied if heterogeneity was significant (I2≥ 50% orp≥ 0.10). Sensitivity analysis assessed robustness and publication bias was examined using funnel plots and Egger’s test (p< 0.05 significant).Results.Fifteen studies were included, analyzing different immune checkpoint inhibitors with 2–3 cycles of neoadjuvant therapy. Surgery occurred 10–45 days post-treatment. The pooled surgical resection rate was 98.96% (95% CI: 98.93–98.98, I2= 0%). The conversion to thoracotomy rate was 16.49% (95% CI: 12.95–20.03, I2= 89.74%). Minimally invasive surgery was performed in 53.62% (95% CI: 49.53–57.72, I2= 95.92%). The median surgical delay was 28.53 days (95% CI: 23.66–33.41, I2= 0%). Surgical time averaged 165.27 min (95% CI: 112.32–218.22, I2= 0%), with mean blood loss of 182.0 mL (95% CI: 134.0–230.0, I2= 0%).Conclusions.Surgical intervention following neoadjuvant chemo-immunotherapy for NSCLC is feasible and safe, with a high resection rate (98.96%). Variability in minimally invasive surgery and conversion rates suggests differences in surgical approaches, while surgical time, blood loss, and delay showed consistency. These findings highlight the need for a multidisciplinary approach to optimize patient outcomes.
背景：为全面评估手术安全性，我们对非小细胞肺癌（NSCLC）新辅助化疗联合免疫治疗进行了荟萃分析。方法：本系统综述与荟萃分析遵循PRISMA指南（PROSPERO注册号：CRD42023470682）。文献检索与数据提取由两名评审员独立完成。主要结局指标包括手术可行性与安全性。计算合并患病率及其95%置信区间（CI）。当异质性显著时（I²≥50%或p≥0.10）采用随机效应模型。通过敏感性分析评估结果稳健性，并采用漏斗图与Egger检验检测发表偏倚（p<0.05视为显著）。结果：共纳入15项研究，涉及不同免疫检查点抑制剂联合2-3周期新辅助治疗方案。手术在治疗结束后10-45天进行。合并手术切除率为98.96%（95% CI：98.93-98.98，I²=0%）。中转开胸率为16.49%（95% CI：12.95-20.03，I²=89.74%）。微创手术实施率为53.62%（95% CI：49.53-57.72，I²=95.92%）。中位手术延迟时间为28.53天（95% CI：23.66-33.41，I²=0%）。平均手术时间为165.27分钟（95% CI：112.32-218.22，I²=0%），平均失血量182.0 mL（95% CI：134.0-230.0，I²=0%）。结论：NSCLC新辅助化疗联合免疫治疗后实施手术干预具有可行性及安全性，且切除率高（98.96%）。微创手术实施率与中转开胸率的差异提示手术策略存在异质性，而手术时间、失血量及延迟时间等指标呈现一致性。这些发现凸显了通过多学科协作优化患者结局的必要性。
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